Extra body fat increases a person's risk of diabetes, heart
attack, stroke, Alzheimer's disease, kidney and liver failure,
amputation, blindness, early death and a long list of other problems
nobody wants. Research tells us that. But how does it actually
happen? The Gazette-Mail asked medical experts to explain, in plain
language.
"Start with this fact," Dr. Sally Swisher said. "If you eat more
sugar than you burn with exercise, your body generates fat."
Swisher is a neurologist and bariatric doctor at Charleston's
Medical Weight Loss and Skin Care Clinic.
The body turns food into glucose, she explained. It's
straightforward, almost mathematical. Your muscle cells use most of
the glucose for fuel. If you exercise a lot, your muscles burn up a
lot of glucose. If you're a couch potato, your glucose doesn't burn
up - and the body converts it into fat.
Globs of sunny yellow fat - unused glucose - float through your
arteries in your blood to the organ or tissues where they are
deposited.
"Picture your arteries coming out of your heart like big rivers,"
Swisher said. "The farther they are from the heart, the smaller they
get, and the easier it is for fat to clog them up. By the time
arteries get to your feet and hands, they're tiny."
Fat cells float through these arteries. Along the way, they are
deposited on tissue and organs. When fat finds a home in an organ,
it can cause problems. If enough fat is deposited, it causes big
problems.
That's an "extremely simplified version of the way it happens,"
Swisher said.
Inside the arteries, fat aggravates the walls as it floats along,
then inflames them, Swisher said. "Fat cells slip underneath the
inflamed lining. That constricts the artery. It used to be called
hardening of the arteries."
If the inner artery wall becomes harder and rougher, the blood
has a harder time getting through, and blood clots are more likely
to form.
"There is bad fat and good fat," Swisher said. Exercise generates
good fat, known as HDL cholesterol. It lowers all kinds of health
risks. Bad fat - called triglycerides and LDL cholesterol - inflames
artery walls. "It's not just innocent baby fat," Swisher said.
"When we are children, our bodies create the number of fat cells
we will have for the rest of our lives, research shows," she said.
"If people have too many fat cells when they reach adulthood, they
are more likely to have trouble with weight for the rest of their
lives."
What damage can it cause?
Extra weight can raise a person's risk of many different kinds of
problems:
Heart failure: "A hundred extra pounds makes your heart muscle
thicken, just like any muscle working overtime," Swisher said. "A
bigger heart eventually leads to heart failure."
A heart has to work extra hard to pump blood through a large
body. The strain can cause a heart attack or stroke.
Fat can be especially dangerous inside arteries that supply the
heart. It interferes with heart function and can set off heart
attacks.
Sleep apnea, which is almost always caused by obesity, Swisher
said. "Obese people often have fat in the back of their throats.
When they lie down, the weight of their chest is on top of them.
They don't have enough oxygen, so they wake up tired, or their
spouse hears them struggling to breathe."
Diabetes: Belly fat has a lot to do with Type 2 diabetes, which
used to be called "adult onset" diabetes. Thirty years ago, people
under 20 almost never got it. Now it is showing up in obese
teenagers and children.
Type 2 diabetes - 90 to 95 percent of all diabetes - can be
prevented with exercise and healthy diet.
Parkersburg native Dr. Frank Schwartz, who directs the diabetes/
endocrine program at Ohio University, explains the role fat plays in
diabetes:
Glucose (digested sugar) can't enter the cells to provide fuel
without insulin, a hormone secreted by the pancreas. Insulin
interacts with the glucose and lets it enter the cells, like a key
that opens the door to the cell. But fat secretes hormones that can
keep the key from working.
When glucose can't enter the cells, that's called insulin
resistance. The more fat, the more interference. The more
interference, the more insulin resistance.
When glucose cannot enter the muscle cells, a person has
diabetes. Digested sugar stays in the person's bloodstream and his
or her blood sugar goes up. The body converts much of the sugar into
fat.
Type 2 diabetes can start in the body 10 years before a person
feels symptoms, research says. If a 30-year-old develops diabetes,
it might have started at age 20. When a 15-year-old develops
diabetes, it might have started at age 5.
Physical activity counteracts insulin resistance and increases
the amount of glucose that can reach the cells. "That's a major
reason why physical activity can prevent diabetes or help make it
better," Swisher said.
Amputation: When little arteries get clogged with fat,
circulation is cut off to the body parts farthest from the heart:
including feet and hands. They don't heal well from infection and
may get ulcers and gangrene. "That puts you at risk of amputation,"
Swisher said.
Kidney failure: "If small arteries leading to the kidneys get
clogged, your body tries to overcome it, but after awhile, your
kidneys just quit working," Swisher said. After that, a person needs
expensive, time-consuming dialysis - often four hours a day, three
days a week, running the entire blood supply through a cleaning
machine.
Stroke: Diabetics are more likely to have strokes, caused by
constriction of small brain arteries. "That leads to clogging of the
carotid arteries, which leads to strokes," Swisher said. Plaques of
inflamed cells and fat build up inside the artery.
"People in their 30s and 40s with high cholesterol who smoke can
have a premature stroke," she said. "If we don't get a grip on this,
it's a matter of time till teenagers start having heart attacks and
strokes."
Alzheimer's disease: In 2008, researchers found that obese people
are twice as likely to get Alzheimer's as healthy-weight people are.
Healthy-weight people with a "spare tire" are twice as likely to get
dementia as healthy-weight people with no spare tire, they found.
Nobody knows yet why that happens.
Liver disease: Fat deposited on the liver can lead to cirrhosis
of the liver. Obesity causes more liver failure than alcoholism
does, according to the Centers for Disease Control and Prevention.
Cancer: Estrogen is stored in fat, so excess fat creates higher
estrogen levels in the blood. "Extra estrogen in the blood also puts
you at risk of cancers of the breast and uterus," Swisher said. The
lining of the uterus may also get thicker with excess weight, which
can cause cancer.
"Colon cancer is also related to obesity, though nobody knows
why," she said.
Sexual dysfunction: Diabetes causes impotence in men, and very
obese young women often don't ovulate. "They're infertile and have
high insulin levels," Swisher said. "If they lose weight, they can
become fertile again. Doctors joke that pregnancy is a side effect
of weight loss."
Incontinence: "If a woman has 50 or 60 extra pounds, and she
rides a bike or just sneezes, the pressure of the belly against the
bladder can force urine out," Swisher said. A woman can undergo
surgery to lift the bladder - or she can lose weight, making the
surgery unnecessary.
Musculoskeletal problems and arthritis: "If weight-bearing joints
carry too much weight: knees, feet and, to a lesser extent, hips,
the amount of arthritis accelerates as you get older," Swisher said.
"Overweight people don't get over it as easily. Rehab is harder."
Blindness: Diabetes also can cause blindness. Fat clogs the
artery leading to the retina, and "that can cause stroke in the
eye," Swisher said. Young overweight girls can also go blind with
"false tumor" condition, she said, in which fat creates pressure
inside the skull, causing severe headaches. The bulge in the optic
nerve may resemble a brain tumor.
"None of these things has to happen," Swisher said. "That's the
important thing to remember. It's possible to prevent them all with
exercise and diet. It's within most people's reach.
"If I were queen of the world," she said, "the first thing I'd do
is take control of school lunches and get kids outside playing every
day again."
KATE LONG | Sunday Gazette-Mail I have patients lift this rubber
model of five pounds of fat when theyre disappointed that they only
lost five pounds, said Dr. Sally Swisher, neurologist and bariatric
doctor at Charleston Medical Weight Loss and Skin Care Clinic. They
feel how heavy it is and realize that five pounds is a wonderful
thing not to have to carry around anymore.
Reach Kate Long at 304-348-1798 or katelong@wvgazette.com.
This story was written with the help of the Dennis A. Hunt Fund
for Health Journalism, administered by the California Endowment
Health Journalism Fellowships at the USC's Annenberg School for
Communication and Journalism.